[Federal Register Volume 75, Number 9 (Thursday, January 14, 2010)]
[Notices]
[Pages 2105-2106]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-562]
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Notices
Federal Register
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This section of the FEDERAL REGISTER contains documents other than rules
or proposed rules that are applicable to the public. Notices of hearings
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Federal Register / Vol. 75, No. 9 / Thursday, January 14, 2010 /
Notices
[[Page 2105]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of Inspector General
Publication of OIG Updated Special Fraud Alert on Telemarketing
by Durable Medical Equipment Suppliers
AGENCY: Office of Inspector General (OIG), HHS.
ACTION: Notice.
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SUMMARY: This Federal Register notice sets forth the recently issued
OIG Updated Special Fraud Alert addressing telemarketing by durable
medical equipment (DME) suppliers. For the most part, OIG Special Fraud
Alerts address national trends in health care fraud, including
potential violations of the anti-kickback statute for Federal health
care programs. This Updated Special Fraud Alert updates the Special
Fraud Alert on Telemarketing by Durable Medical Equipment Suppliers
originally issued in March 2003 and continues to highlight the
statutory provision prohibiting DME suppliers from making unsolicited
telephone calls to Medicare beneficiaries regarding the furnishing of a
covered item.
FOR FURTHER INFORMATION CONTACT: James A. Cannatti III, Senior Counsel,
Office of Counsel to the Inspector General, (202) 205-0007.
SUPPLEMENTARY INFORMATION:
I. Background
The Office of Inspector General (OIG) was established at the
Department of Health and Human Services by Congress in 1976 to identify
and eliminate fraud, waste, and abuse in the Department's programs and
to promote efficiency and economy in departmental operations. OIG
carries out this mission through a nationwide program of audits,
investigations, and inspections. To reduce fraud and abuse in the
Federal health care programs, including Medicare and Medicaid, OIG
actively investigates fraudulent schemes that are used to obtain money
from these programs and, when appropriate, issues Special Fraud Alerts
that identify practices in the health care industry that are
particularly vulnerable to abuse.
OIG issues Special Fraud Alerts based on information it obtains
concerning particular fraudulent or abusive practices within the health
care industry. Special Fraud Alerts are intended for widespread
dissemination to the health care provider community, as well as those
charged with administering the Medicare and Medicaid programs. To date,
OIG has published in the Federal Register the texts of 12 previously
issued Special Fraud Alerts.\1\
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\1\ All OIG Special Fraud Alerts are available on the OIG Web
site at: http://oig.hhs.gov/fraud/fraudalerts.asp.
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This Updated Special Fraud Alert updates the Special Fraud Alert on
Telemarketing by Durable Medical Equipment Suppliers originally issued
in March 2003 and continues to focus on section 1834(a)(17) of the
Social Security Act, which prohibits suppliers of DME, except under
limited circumstances, from making unsolicited telephone calls to
Medicare beneficiaries regarding the furnishing of a covered item, and
possible telemarketing practices by DME suppliers through the use of
independent marketing firms.
II. Updated Special Fraud Alert: Telemarketing by Durable Medical
Equipment Suppliers (November 2009; Original Published March 2003)
Section 1834(a)(17)(A) of the Social Security Act prohibits
suppliers of durable medical equipment (DME) from making unsolicited
telephone calls to Medicare beneficiaries regarding the furnishing of a
covered item, except in three specific situations: (i) The beneficiary
has given written permission to the supplier to make contact by
telephone; (ii) the contact is regarding a covered item that the
supplier has already furnished the beneficiary; or (iii) the supplier
has furnished at least one covered item to the beneficiary during the
preceding 15 months. Section 1834(a)(17)(B) specifically prohibits
payment to a supplier that knowingly submits a claim generated pursuant
to a prohibited telephone solicitation. Accordingly, such claims for
payment are false and violators are potentially subject to criminal,
civil, and administrative penalties, including exclusion from Federal
health care programs.
The Office of Inspector General (OIG) has received credible
information that some DME suppliers continue to use independent
marketing firms to make unsolicited telephone calls to Medicare
beneficiaries to market DME, notwithstanding the clear statutory
prohibition. Suppliers cannot do indirectly that which they are
prohibited from doing directly. OIG has also been made aware of
instances when DME suppliers, notwithstanding the clear statutory
prohibition, contact Medicare beneficiaries by telephone based solely
on treating physicians' preliminary written or verbal orders
prescribing DME for the beneficiaries. A physician's preliminary
written or verbal order is not a substitute for the requisite written
consent of a Medicare beneficiary.
Except in the three specific circumstances described in the
statute, section 1834(a)(17)(A) prohibits unsolicited telemarketing by
a DME supplier to Medicare beneficiaries, whether contact with a
beneficiary is made by the supplier directly or by another party on the
DME supplier's behalf. Moreover, a DME supplier is responsible for
verifying that marketing activities performed by third parties with
which the supplier contracts or otherwise does business do not involve
prohibited activity and that information purchased from such third
parties was neither obtained, nor derived, from prohibited activity. If
a claim for payment is submitted for items or services generated by a
prohibited solicitation, both the DME supplier and the telemarketer are
potentially liable for criminal, civil, and administrative penalties
for causing the filing of a false claim, as well as criminal and civil
penalties for using interstate telephone calls in furtherance of
schemes to defraud.
What To Do If You Have Information About Fraud and Abuse Involving
Medicare or Medicaid Programs
If you have information about DME suppliers or telemarketers
engaging in any of the activities described above, contact any of the
regional offices of OIG, U.S. Department of Health and
[[Page 2106]]
Human Services, at the following locations:
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Regional offices States served Telephone
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Boston.................................. MA, CT, ME, NH, RI, VT......... 617-565-2664
New York................................ NY, NJ, PR, VI................. 212-264-1691
Philadelphia............................ PA, DE, DC, MD, VA, WV......... 215-861-4586
Atlanta................................. AL, GA, KY, NC, SC, TN, MS..... 404-562-7603
Chicago................................. IL, IN, MI, MN, OH, WI......... 312-353-2740
Dallas.................................. TX, LA, AR, OK, NM............. 214-767-8406
Kansas City............................. MO, ND, SD, MT, KS, IA, CO, NE, 816-426-4000
UT, WY.
San Francisco........................... No. CA, OR, WA, ID, AK......... 415-437-7961
Los Angeles............................. So. CA, AZ, NV, HI............. 714-246-8302
Miami................................... FL............................. 305-530-7756
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Dated: December 14, 2009.
Daniel R. Levinson,
Inspector General.
[FR Doc. 2010-562 Filed 1-13-10; 8:45 am]
BILLING CODE 4152-01-P